Some of the biggest global healthcare challenges are the collection of non-communicable diseases such as cancer, diabetes and heart disease. Sedentary lifestyles and unhealthy eating habits, particularly in certain regions such as the Middle East – alongside risk factors such as high blood pressure and obesity – mean that these affect a worryingly high percentage of the population.
As consumers become more health literate, it’s somewhat frustrating that in the face of myriad awareness campaigns around nutrition, smoking and exercise, there doesn’t appear to be a huge shift in changing behaviours.
When we are looking specifically at health disease awareness campaigns, we need to think carefully about what we want the outcome to be. Do we want to merely raise awareness, or do we actually want to influence and change behaviours? Is it enough for people just to know they are at risk of heart disease if they make certain lifestyle choices, or can we do more to persuade them to make better choices?
Communities are bombarded with facts and figures, such as recommended calories and minutes per day of exercise, as well as ideal BMI and weights. But with this cold and objective information, are we actually missing the key to capturing attention and addressing behaviour? Do people not remember the information or are they wilfully – or even subconsciously – ignoring it?
Those of us working in marketing and communications often use market research to help us to build informed strategies to address the needs of consumers. However, this type of data, which gives a picture of conscious decision-making, only tells half a story. It is tainted by cognitive bias – that is, it fails to uncover – or even recognise – those less tangible factors that subconsciously influence the decisions we make and reflect our nature as emotional, impulsive and irrational beings. It answers the ‘what’ and the ‘how’ for consumers but it cannot really address the ‘why’. Understanding non-conscious decision making is emerging as a real area of importance for communicators because psychologically, bias trumps logic, so finding the right motivators is essential to drive behavioural change.
Of the different biases that affect our healthcare decision making, two stand out that we must counter when thinking about educational campaigns. The first is present bias, which reflects our desire for instant gratification, and challenges our ability to act now for a future benefit. Present bias makes it much harder to make positive decisions that we know will benefit our health long term, but might be harder in the moment (think the gym on the one hand, or Netflix and sofa on the other).
The second is our limited attention, which considers the functional decisions we have to make to stay alive – the financial, familial and other pressures. Positive healthcare decisions and changes require mindspace that may not exist in the face of everything else – particularly for low income, time-poor individuals. Habits, mental shortcuts and reminders help us to navigate our choices moment to moment and reduce the number of conscious decisions we have to make.
Within any specific healthcare context, be it screening, diagnosis, treatment adherence, or follow up, specific biases will influence patients in their decision making. Psychological testing is potentially an effective way to uncover some of the non-conscious influences of behaviour. This could identify fear, societal or familial pressure, presumed knowledge, desire to follow the crowd, desire to stand out – the list goes on.
Non-conscious testing can uncover behavioural patterns and prioritise them in order of importance in a way that traditional research simply cannot. And the kicker is this: once we know and understand these biases, we can use psychological tools and ‘nudges’ to design strategies that address them. We need to find ways to make choices appeal in the moment and we need to help people form new habits and mental shortcuts. It needs to be easier or more rewarding to make a good health decision than a poor one.
But, how do we incentivise people to make a good choice? How do we help people make small commitments to build new habits? From a communications perspective, this is where creativity comes into play. In advance of the 2014 Winter Olympics, Olympic Change, the group in charge of ticketing, wanted to get Russians active and amped up for the games, so they offered a free subway ride in Moscow in exchange for 30 squats. The financial reward may have been small, but it was immediate and real, and it got people moving. Ok, this won’t necessarily build a long-term habit, but it’s easy to see how this simple yet creative idea could be applied elsewhere.
On a more strategic level, there are health insurers in the UK and elsewhere slashing insurance premiums for those who allow their exercise and nutrition to be monitored. This has been in place for more than 10 years. Organ donation is also a great example. How do you get people to register as an organ donor? You make it the default option. You make it easier for someone to be a donor than not to be one. In an analysis of government registries across Europe, the effective consent rate for organ donation was between 86 and 99% in opt out countries, vs a maximum of 28% in opt in countries1. When people don’t have strong preferences, the use of defaults can have a significant impact.
According to the Imperial College London Diabetes Centre, diabetes rates in the UAE are rising faster than anywhere else in the world, driven by limited exercise and unhealthy diets. We need to think differently to make change. Encouraging good health decisions is not just about educating people, it’s about understanding their motivations and changing the environment around them to make the default choices the right one. In this region, and particularly in young countries such as the UAE where socioeconomic development continues at an astronomical rate, rather than look at targeting the people, the question we should be asking is this: how can organisations and companies help create an environment in which the better decision for individuals is the easier and more obvious one? If we succeed, a healthy community becomes the default rather than the aspiration.
1. Johnson, E. J., & Goldstein, D. Do defaults save lives? Science. 2003; 302, 1338- 1339.